Open Source Software and the Electronic Health Record

Report
Open Source Software
and the Electronic
Health Record: An
Introduction
Ralph La Tella HIM
What is Open Source
Software?
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Software whose code is released openly
without traditional licensing restrictions
Source code (computer program) may be
modified or improved by user of the software
and then re-distributed
Some call it “free software” but the only
freedom you have is to be able to modify it
The reality is that a lot of it is actually “free” or
available at a very low cost
Examples of Open Source
Software


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Fire Fox web browser
Moodle e-learning
platform
MySQL Relational
Database Management
System
GIMP (Open Source
version of PhotoShop)
PSPP – Free alternative
to SPSS
Typical Open Source Platforms
for EHRs
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Are web-based and delivered to your PC
through your internet browser
Hosted on an Open Source server: usually
Linux-based and (although can be done in
Windows) called APACHE (OSS)
Use a programming language called PHP
(OSS)
Use a widely implemented database
application called MySQL (OSS)
Open Source EHRs: Framework
Open Source EHRs

Example:
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OpenEMR (available online at www.oemr.org)
Click here to demo on a live server install
Some features:
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Practice Management features for patient scheduling, patient
demographics
Electronic Medical Records - creating an on-line record of
patient encounters
Ability to enter CPT and ICD codes at the end of a patient
encounter
Advanced reporting capabilities
Prescription writing capability with ability to email or print
prescriptions
HL7 support to parse HL7 messages
Open Source EHRs
OpenVista (Veteran’s Affairs USA) – login screen:
OpenVista Patient summary
OpenVista – w/PACS module
Open Source EHRs
Why?
To Cut Cost$
Open Source EHRs - Why?

The High Cost associated of proprietary EHRs
 Recent research in the USA reveals that only 1.5% of
hospitals there have a comprehensive EHR system
in place (Jha et al. 2009)

The same study also pointed to capital costs as the
single biggest barrier to the adoption of the EHR in
the hospitals surveyed (n= 3049) with maintenance
costs cited as the next major barrier to EHR
adoption.
Why Open Source EHRs? –
cont’d
“The open source software (OSS) approach to
EHR implementation represents a promising
and affordable alternative, increasing the
overall cost-effectiveness of healthcare IT
without sacrificing performance and patient
safety.“ (Vlaicu, 2009).
Why Open Source EHRs? –
cont’d

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There are almost 30 million health records
created using OSS in the USA.
Recognising the importance of nonproprietary and Open Source software as a
potential solution to the EHR, the Department
of Health and Human Services has been
commissioned a study to report on the
subject by 2010. (Vlaicu, 2009).
Why Open Source EHRs? –
cont’d

“Open Source is the only way that the (US)
administration can drive health care IT
adoption.” (Vaughn-Nichols 2009)
Predictions
Gartner (USA) has predicted that:
 By 2010, 90 percent of Global 2000 organizations will have
formal open-source acquisition and management strategies.

By 2009, OSS solutions will directly compete with closed-source
products in all software infrastructure markets.

By 2010, open source will be included in mission-critical software
portfolios within 75 percent of Global 2000 enterprises.

By 2010, Global 2000 IT organizations will consider open-source
products in 80 percent of their infrastructure-focused software
investments and 25 percent of business software investments
Source:
http://healthcareinformatics3000feet.blogspot.com/2009/02/ehrand-open-source-software.html
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OSS, EHRs & the HIM
HTML Data Entry Form
Admin entry
Clinical notes
Form Validation
HIMs
Business/Clinical Logic
Dynamic Results fed back
to HTML Data Entry form
Web
Server
Database Server/
Application Server
Opportunities for HIMs in the
Implementation of OS EHRs
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OSS EHRs may be modified/customised
according to specific requirements – asset
Core modules rely on HTML forms to effect
data entry – forms design using Web 2 tools
eases the forms design process (little/no
programming required)
Forms “connect” to the application using
business logic that may be modified
according to user’s needs
Opportunities for HIMs
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Data verification logic – a new field for
existing HIM skills
Application modules are database-driven
using OS industry standard software such as
MySQL – fully SQL compliant – easy to learn
database especially for those with experience
using MS SQL server
Capacity to gain sought-after Internet/web
security skills
Opportunities for HIMs

Apply medico-legal expertise to the
development of standards governing
jurisdictional issues – who owns the EHR
since the application “driving” it is in the
Public Domain (i.e. Open source)
Issues & Considerations
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The usual:
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The unusual:
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Privacy & Confidentiality (esp. with distributed systems)
Ownership & Governance (esp with PCHRs)
Where does the buck stop?
 Free software but maintenance an issue
 End user training – the hidden costs
 Who do you turn to for support – Forums?
 Modified software – a legal minefield?
The perfect opportunity for the enterprising HIM to
get in on the ground floor!
The End……of the beginning?

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